Men Health

The information is mostly pertains to heterosexual males. Non-heterosexual men (including Gay men and transexuals) may relate to this information in many respects. However, there are other unique psychological and interpersonal dynamics that pertain specifically to non-heterosexual males.

Overview of Men’s Issues

Historical and Cultural Factors

Presenting Problems By Men

Male Developmental Issues

Men’s Relationship Issues

The Medical Model and Men’s Issues

Case Example of Men’s Issues

Therapy for Men

Resources Related to Men's Issues

Overview of Men’s Issues

The field of male psychology, and psychotherapy methods designed specifically for men, are relatively new phenomena. For most of human history, men were defined by their distinct, limited roles as hunters, warriors, and primary providers for their family, tribe and community. These roles were never questioned or debated – and certainly not psychoanalyzed. Sigmund Freud, the founder of psychoanalysis and modern psychology, and other leading pioneers in the fields of psychology and psychiatry had little to say about a distinct male psychology.

Today, there is a growing list of psychologists, research scientists, and other experts who are making major contributions to the understanding of men, from a psychological and interpersonal perspective (Bergman, Pollack, Real, Stosny, Wexler, among others). The fields of cultural anthropology, modern brain science, and psychology are creating a new paradigm for helping men define themselves and their roles today. We no longer need to be restrained by the limitations imposed by the cultural traditions of the “traditional, masculine male” which was the expected model or standard for men prior to the late 20th century (and a standard that continues to exert influence for many men and women today). Nor do we need to react with guilt, shame, or submissive attempts to re-define the male persona as a result of certain messages that evolved from the modern women’s movement.

It seems that we are re-discovering the undeniable fact that men and women are actually quite different. And we are beginning to develop a coherent and compassionate understanding of healthy, normal male emotion, behavior, and relationship dynamics. The psychologist B. Mark Schoenberg (Growing Up Male, 1993) describes a basic foundation for understanding the differences between men and women.

Man’s earliest ancestors lived in a harsh and hostile environment that placed a high premium on physical strength. The strong survived, and the weak lived exceedingly brief lives… Because he was the fighter and because he was the provider, it was inevitable that the male came to be responsible for woman’s welfare. This is the historical reality. Gender differentiation evolved out of actual physical, perhaps physiological, necessity.

This biological foundation, along with recent findings from modern brain science, helps to explain why men do what they do, feel what they feel, and how they struggle with confusing, even conflicting contemporary role demands and expectations.

Historical and Cultural Factors

Men have primarily been defined by their work roles (along with conquests and success in business, sports, wars, and other ventures), not by their role relationships within families or other social groupings. Historically, men were dominant over women, driven primarily by physiological factors, and the major forces of historical change were conducted by powerful male rulers and military leaders, a male-dominated church, and other powerful men. In the modern era, male stereotypes developed as a result of cultural ideals created in literature, movies, and television (cowboy, romantic hero, soldier, 1950’s family man, and even the angry, bigoted archetypes like Archie Bunker). Currently we are influenced by post-feminist stereotypes such as the bumbling, ineffective and inarticulate man, or just the insensitive “cave man” who “cannot communicate”. The role of men in the workforce, relationships and society has changed dramatically in recent history, as a result of revolutionary economic and social changes. Until very recently, there was no need or expectation for men to communicate in an intimate manner. There was no historical necessity for men to talk about their feelings, to be emotionally sensitive to others, or to “validate” women or children.

Presenting Problems by Men

Men confronting the new demands and expectations of the 21st century are experiencing increasing levels of stress - often work or relationship related. This stress, and the new, complicated role requirements men face today, often result in the following types of problems, often seen in therapists’ offices today:

• Anger (in relationships, the workplace, road rage)

• Stress (often work related; and commonly presented with somatic complaints or feelings of irritation, frustration, and anger)

• Depression (often expressed as boredom, lack of motivation, or just being “stuck in the mud”)

• Relationship problems (crises often precipitated by a wife or girlfriend who is fed up; or the man feels he is no longer “in love”).

Fear and shame deserve special mention here. The problems men experience today often result in, or are influenced by, these emotional states. Fear and shame result from messages that men are not doing the job – in the work place, or at home. And the job is increasingly difficult to accomplish today, because the man as sole bread winner is unrealistic in this economy. In a sense, life was much easier for men in the past, when they were simply hunters and warriors. A complicating factor is the male tendency to fear any “feminine” aspect of their personality, behavior or feelings. Men, who are raised predominately by women, are afraid that certain emotions, and their need for nurturance, means they are not masculine. If they are emotionally vulnerable, sensitive, or dependent on others, they feel ashamed and out of control. A man who is shamed by childhood abuse or enmeshment with an overprotective mother may become emotionally hypersensitive and subject to narcissistic injury (any perceived insult, complaints, criticism, or unmet entitlement needs lead to excessively hurt, angry feelings).

Male Developmental Issues

There are many challenges for boys learning to be men today, particularly in families where effective male role models are not fully available. In too many families, distressed parents are angry, rejecting, or even abusive. The male brain often adapts to these circumstances, and can result in defensive role rigidity, anger and rage. Boys learn during childhood to suppress emotion – for boys becoming men, feelings and their expression can be considered shameful. To complicate this situation, boys are not generally socialized or taught to connect, bond, or develop meaningful, emotionally supportive relationships – especially with other boys and men. Boys are physiologically and neurologically oriented toward action, tasks, and playing with objects – not toward relating interpersonally. Raised primarily by women, boys get most or all of their emotional needs met by women without any required reciprocity on their part. This results in emotional, narcissistic injuries as adults when their needs and expectations are not met. Anger develops as a coping mechanism. William Pollack (1995) says that anger is their “way of weeping” – the way they express their emotional pain.

Men’s Relationship Issues

Male attachment needs are somewhat different from women’s. Men generally do not need verbal communication about feelings or “talks” about the relationship. Nor do they need direct, verbal validation of their feelings or needs. Men have a natural, biological proclivity toward interaction with the environment, more so than the verbally based interactions that women desire. They do need to know they are appreciated, respected and loved. And men are often quite satisfied by having these needs met with direct, physically nurturing behaviors by women. Many adult men feel a basic sense of security and even love simply by the very presence of the significant women in their lives. Men also experience sexual connection as a form of nurturance, acceptance, love, and even emotional security. Sex for men is a primary attachment need – compared to women, who need verbal communication and validation. Men also tend to have fewer friends than women, and when they do, they tend to focus on activities rather than verbal interactions (watching sports, hunting and fishing are examples).

The Medical Model and Men’s Issues

Recent findings from modern neuroscience and interpersonal neurobiology show there are unique aspects of the male brain (also endocrine and other systems) – quite different from female brains. This includes analytical brain structures (not emotional) designed to solve problems. Men have an inborn, biologically based competitive instinct. They also have an area of the brain designed for sexual pursuit that is more than 2 times larger than females (Brizendine, 2010). The brain circuits for fear, aggression and defense are far more prominent in men than in women. In comparison, women have more prominent mirror neuron systems for emotional empathy.

There are no male-specific diagnoses in the Diagnostic and Statistical Manual of Mental Disorders. The most common diagnoses for men are addictions, personality disorders such as narcissism, avoidant, and anti-social personality disorders, intermittent explosive disorder, conduct disorder, and ADHD. Depression, however, is very common in men. Men also experience complicating medical issues such as stress-related heart and digestive disorders, and they may also present with a variety of sexual disorders. Other medical concerns may result from drug and alcohol addiction.

Case Example of Men’s Issues

A men’s therapy group, which was established a little over a year ago, has 8 members and one male therapist. The group meets weekly, for 2 hours. The average age is early 40’s, most of the men are married, and all report a history of relationship problems. Three of the men have had problems with addictions, and are either in recovery (attend 12 step groups) or abstinent. Several have anger management problems, some self-sabotage in work and relationships, and all have identified self-doubt and shame as major concerns. There is open discussion, lots of problem solving by the members (men like to fix things), along with education about men’s issues and other interventions by the therapist. The group is process oriented – there is a focus on the here and now - especially their interactions and feelings during group meetings. The patterns of interaction in the group, along with their emotional reactions to each other, are discussed – this helps the men recognize and understand their feelings and relationships outside of the group. Over time, the men have become quite open and supportive in this accepting and non-judgmental environment.

John, one of the original members, age 42, owns a small company, and has been married for 16 years. His primary complaint was the volatile relationship with his wife (loud arguments, often followed by distance and avoidance). John used to complain that she nagged incessantly, she spent too much money, and he said they had a lousy sex life. He was quite angry with her and thought about having an affair. He also complained about the stress of owning a small business, and working longer and harder due to the economy. To cope, he would drink excessively at times. The men in the group like John – he jokes around with them, he is warm and affable, and has good insight at times. He is seen as a leader in the group. However, the men see how John avoids responsibility at times by blaming others or circumstances, and he often avoids dealing with his feelings and the problems in his life. John has made progress with the support of the men in the group, who have challenged him to look at his avoidance and his role in these problems. John is getting more clear about how he uses anger and blame to protect his underlying feelings of shame and fear (stemming from childhood wounds – an enmeshed mother and an absent, alcoholic father). John is now telling the group about improvements in the relationship with his wife – less emotional reactivity when she makes complaints, less fighting and distance, and he’s more responsive to her feelings and needs.

Therapy for Men

Men are far less likely to seek help than women, and they often delay getting help until there is a crisis. Men are less likely to follow through with treatment recommendations by therapists and psychiatrists. The problem is not as simple as “resistance”. Rather, asking for help is viewed or felt by men as shameful. A man solves his own problems – that’s why men don’t ask for directions! Therapy was also designed almost exclusively as a “talking cure” – and the male brain and culture is not designed for a lot of verbal communication about feelings, relationships, or personal problems. That’s why men tend to be more guarded and defensive in therapy (based in fear and shame). It is not surprising that only about 1/3 of all therapy clients are men.

What can be done? Therapists need to “normalize” men’s feelings, behavior, and their tendency to be defensive. David Wexler suggests that therapists empathize with a man’s anger, and reframe his behavior by letting him know that he is not a bad man – he’s a good man who never learned how to deal with his needs and feelings more effectively. In couples therapy, men can learn what the feelings mean (both her feelings and his), why she says what she says, why she does what she does, and men can learn what a woman really wants. Men do best with tasks – homework assignments, and specific behavior change that makes sense. After all, most men want to protect and provide, and they are happy to succeed in those areas when the task is realistic and appropriate. Finally, men’s therapy groups are often less threatening than individual or couples therapy, and can be extremely helpful. In these groups, men get support from other men who identify with each other – this normalizes their “problems” and men will often take good advice more readily from a man he can identify with.